Background: A Member Portal is a one-stop, user-friendly self-service tool for members to manage and view health care coverage information. It allows members to track out-ofpocket expenses, find information about Medical Claims and Explanation of Benefits, review a Summary of Benefits and other important plan documents, print and order an ID Card, request PCP change request, and find pricing and coverage information for a specific medication using the “Formulary.”
Problem: The main issue was not in displaying the administrative records, but rather accessing and pulling information simultaneously from various systems, such as medication from Pharmacy Benefit Management System or pulling medical records from EHR systems and checking claims records for any gaps in care and last doctor’s visit. This information could be hosted with other vendors internally or externally, which poses an issue when locating it.
Solution: Eixsys has developed various solutions for multiple insurance carriers for their member portal solution. The portal allows for efficient, convenient workflow to manage the system and pull all related information from various systems to establish transparency between health plans and members.
Result: Members were able to track medical expenses, view eligibility, claim status, authorization and referral status, current medications, and all information regarding dependents under the age of 18 years. They are much more equipped for health care financial planning, as they can see benefit accumulators, such as how much has been met on their deductible, as well as view copayment amounts. In addition, this portal allows members to see how much they owe on their premiums and provides the option to pay them. Members also experience convenience, as this portal allows members the ease of accessing and changing information, such as changing primary care providers, requesting ID cards, downloading medical records.